The Blackwell Companion to Medical Sociology

154 Elianne Riska
research has given the state a central role in shaping the conditions of health
professions (see Jones 1991; Hafferty and McKinlay 1993; Johnson et al. 1995)
and for obvious reasons: health care systems with publicly financed and run
medical care, with a large fraction of physicians being salaried employees, and
public health nurses and general practioners working at local health centers
constitute a different arena for the relationships between various health professions
than the market-oriented American health care context. This research has
also illustrated how external economic and political conditions have influenced
the internal divisions within the medical profession in, for example, Spain, Israel,
Belgium, and the Netherlands (Rodriguez 1995; Shuval 1995; Schepers and
Casparie 1997).
There are, however, a number of issues that have been but sparsely covered in
current research on health professions and occupations. There are, for example,
only a few sociological studies of work pursued in the hospital setting. A number
of sociological classics on the hospital as a social organization ± studies on work
done at the ward and on the external ties of hospitals to the community ± were
done in the 1960s, but presently this institutional settingof medical work seems
mostly to be a research field of health services researchers. While clinics and
office-based practice have been in the focus of sociologists using an ethnographic
and symbolic-interactionist approach, the hospital settinghas received less
attention. The changing nature of the hospital (Armstrong 1998) might partly
explain this void.
Another area related to hospital medicine is the vast array of health professionals,
who do work that does not entail any caring. Laboratory medicine,
medical research, and health care managers include a variety of occupational
groups that have diverse educational backgrounds and occupational loyalties
(Nettleton 1995). These groups have so far been largely ignored in the sociology
of health professions and occupations. Furthermore, efforts to control and
regulate the therapy traditions of physicians by means of evidence-based data
sources constitute a new feature of public health policy. In many countries (e.g.
Sweden and Canada), evidence-based medicine and its emphasis on clinical
guidelines and rules for ``good practice'' represents a professional reform movement,
which is composed of an interestingcoalition of various health professionals.
But to what extent these endeavors constitute a symbolic or real control
over the clinical and professional autonomy of the medical profession is an issue
that needs further sociological study. Obviously, more studies on the occupational
culture of specialist physicians and other health professions will provide a
greater understanding of how health workers construct the content of their
work, and how they accommodate with or overrun the effects of the large
structural changes that are currently taking place in most health care
systems. Here the work by Hughes, Goffman, and Foucault provide useful
theoretical frameworks for understandingthe workplace, the larger institutional
settings, and the cultural arrangements and practices embedded in health care
work.
The interactionist and phenomenological accounts of the work conducted in
health care settings provide a much needed understanding of what Hughes and
Goffman called the social drama of work. In these days of the revival of the